Clatsop County scrambles to improve oversight of developmental disability program

State cited risk to health and safety

Investigations into abuse and neglect at adult foster homes on the North Coast helped unearth a disturbing lack of oversight in Clatsop County’s developmental disability program.

The county contracts with Clatsop Behavioral Healthcare, a private nonprofit, to serve people with intellectual and developmental disabilities like autism, cerebral palsy, Down syndrome and epilepsy.

Clatsop County contracts with Clatsop Behavioral Healthcare, a private nonprofit, to serve people with intellectual and developmental disabilities.

Last May, the state Department of Human Services, after reports of risk to the health and safety of people in care, outlined a pattern of inconsistent monitoring that raised significant concern.

By last fall, the department drew the line. “The state informed the county that there needed to be changes made or the contract would be pulled,” said Monica Steele, the interim county manager.

Steele said the county “spoke with CBH and said, ‘You need to make a change.’”

Clatsop Behavioral Healthcare declined to comment on personnel matters. But several sources, speaking privately, said Roger Bighill, the program manager for developmental disabilities, was removed.

The agency hired Lori Moore as the new program manager, added a quality assurance coordinator and an administrative support staffer and sought expert advice from consultants in making changes.

Over the past several months, the agency increased monitoring of adult foster homes and is working to complete a corrective action plan for the state by March.

“We take the needs of the community very seriously,” said Amy Baker, the executive director of Clatsop Behavioral Healthcare. “We have a really great team who are really dedicated to their clients.”

Both the county and the agency said the lack of oversight identified by the Department of Human Services was related to state investigations into an adult foster home provider, KC Care LLC, based in Seaside.

The state moved to revoke KC Care’s licenses after substantiating reports of abuse and neglect of people in the provider’s care over the past three years. KC Care challenged the state’s findings and continues to operate while administrative and legal appeals are heard.

‘Deep inhale’

Problems with the county’s developmental disability program surfaced publicly after people familiar with the program shared their misgivings with The Daily Astorian.

The newspaper, using the state’s public records law, obtained emails, letters and other documents that detail the state’s distress over management of the program and the agency’s response.

Steele and Michael McNickle, the county’s public health director, said they have confidence in Baker’s leadership and the steps she’s taken to improve the agency. Baker was hired in 2016 as a troubleshooter when three top administrators resigned after more than a year of turmoil over mental health care.

“I think that they are taking a lot of steps to try and make sure that the program is moving in a positive direction,” Steele said.

After the bad experience in 2016, the county is more vigilant in supervising the agency’s contract for mental health and substance abuse treatment. Before the early part of last year, the county’s impression was the developmental disability contract was going well.

“It was a ‘deep inhale’ moment,” McNickle said.

Baker was also a little surprised. “The significance of the situation became apparent, probably right about this time, to me as the executive director,” she said.

Records show the Department of Human Services flagged issues with monitoring adult foster homes and group homes in a two-year review of the program in 2017. The same issues prompted a focused look into case management last spring and influenced the latest review in October.

“Based on documentation available, oversight of group home and foster care provider responsibilities and individual services did not appear to be consistently occurring,” Darlene O’Keeffe, the quality improvement manager for the department’s Office of Developmental Disabilities Services, wrote to McNickle in May.

Emails reveal anxiety among county leaders last summer and fall about the program’s management and whether the agency’s reaction to the state was sufficient.

Heather Reynolds, the county counsel, warned of the gravity of the situation. “I view this matter as extremely serious,” she wrote in June, adding that the liability for the county, given what appeared to be years of escalating care concerns, could be significant. Consultants hired by Clatsop Behavioral Healthcare pinpointed long-standing issues with foster care licensing and found after visiting foster homes that even the minimal standards described in state rules were not always being met. A review of abuse investigations and reports of serious events during the first half of 2018 found responses that lacked the depth and breadth needed to protect people in care.

“We were struck by what appeared to be a lack of urgency about critical issues and poor boundaries with providers,” the consultants, Mary Lanxon and Pat Zullo, wrote in a summary in September.

‘Too informal’

In the past, Baker said, the oversight of adult foster homes was “potentially too informal at times.”

Clatsop Behavioral Healthcare serves 219 adults and children in the developmental disability program, and more than half — 143 — live at home. The others are in foster homes, group homes or supported living.

“In homes where we might have concerns,” she said, “we have dramatically increased the monitoring.”

Baker praised the dedication of the program’s staff and the quality of providers, who not only look out for health and safety, but help vulnerable people flourish.

The agency’s performance will soon be tested when the county, for the first time in a decade, puts the contracts for mental health and substance abuse treatment and developmental disabilities up for bid.

Great article Mr. DePledge but there are several things troubling. First is that the Program Manager answers to his / her superior and in this case it would be to Ms. Baker and to the State, both of whom should have been aware of the issues with providers. In turn Ms. Baker and the State would direct the Program Manager on how to proceed with any course of action, formal or informal. Surely Ms. Baker as well as State Officials should have known from the beginning of the provider issues presented in your article and in doing so should have been proactive in addressing them. With the level of oversight your article states the State and Ms. Baker were involved it's hard to believe the PM acted alone in any decision making, but your article infers the opposite.

Also troubling is the monitoring of foster homes the agency provided. If issues were identified surely they would have been presented not only to the provider for correcting but to the PM, State and finally to Ms. Baker if no resolution. Again, since the PM answers to the State and to Ms. Baker, what was their role in addressing issues and what actions did they direct the PM to take? Especially in a serious matter which this agency is finding themselves one person would not be allowed to act alone in any course of action. So my question is where is the accountability for the State and Ms. Baker in all of this disaster? My interpretation of this article is that the blame has been placed on the Program Manager instead of on the people who directed him to take or not take remedial action? Reputations can be ruined by the omission of facts and truths.

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